Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 27214 | KY |
N | 2080P0201X | Pediatric Allergist | 27214 | KY |
NPI | 1205844511 |
---|---|
Provider Name | Dr. Leslie Bernard Branch |
First Address | Lexington, KY 40503-3004 |
Second Address | Lexington, KY 40503-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64272149 | (05) | KY |
F46096 | (02) | KY |